CPCS Reappointment and Recredentialing 2 — Questions and Answers
Question 1: A hospital's medical staff bylaws state that reappointment applications must be submitted 120 days before privileges expire. A physician submits her application 60 days before expiration. What is the most appropriate action?
- Automatically extend privileges until the process is complete
- Process the application under a focused professional practice evaluation
- Notify the physician of the late submission and follow the bylaw's late-submission policy (Correct answer)
- Deny reappointment due to failure to comply with bylaws
Correct answer: Notify the physician of the late submission and follow the bylaw's late-submission policy
The credentialing office should notify the physician and apply the late-submission policy outlined in the medical staff bylaws.
Question 2: Which of the following best describes 'lapse in privileges' during the recredentialing process?
- Temporary suspension pending investigation
- A gap in clinical privileges that occurs when reappointment is not completed before the expiration date (Correct answer)
- Voluntary relinquishment of specific clinical privileges
- Administrative hold placed by the credentials committee
Correct answer: A gap in clinical privileges that occurs when reappointment is not completed before the expiration date
A lapse in privileges occurs when the reappointment process is not finalized before the provider's current privilege period ends.
Question 3: During recredentialing, a physician's NPDB query reveals a malpractice payment made since the last appointment. What is the FIRST step the credentials committee should take?
- Automatically deny reappointment
- Request a detailed explanation from the physician (Correct answer)
- Report the payment to the state medical board immediately
- Place the physician on proctoring
Correct answer: Request a detailed explanation from the physician
The committee should first request a detailed explanation from the physician before making any determination about reappointment.
Question 4: A telehealth provider seeking reappointment at a distant site hospital relies on credentialing by proxy. The credentialing is based on the originating site's credentials. What document must the originating site provide?
- A copy of the provider's original application
- An attestation that the provider is currently credentialed and privileged at the originating site in good standing (Correct answer)
- The provider's complete primary source verification file
- A letter from the state licensing board
Correct answer: An attestation that the provider is currently credentialed and privileged at the originating site in good standing
CMS and accreditation standards require the originating site to provide an attestation of current good standing for telemedicine credentialing by proxy.
Question 5: An organization's recredentialing cycle is every two years. A provider who was appointed 18 months ago voluntarily resigns. If they reapply 10 months later, how should the organization treat this application?
- As a reappointment since less than two years have passed
- As an initial appointment requiring full primary source verification (Correct answer)
- As a courtesy reappointment with abbreviated verification
- As an automatic reinstatement with no additional review
Correct answer: As an initial appointment requiring full primary source verification
A voluntary resignation followed by reapplication is treated as a new initial appointment requiring complete primary source verification regardless of prior credentialing.
Question 6: Which performance data source is most organization-specific and critical for evaluating a provider's competency during recredentialing?
- NPDB adverse action reports
- Ongoing Professional Practice Evaluation (OPPE) data (Correct answer)
- AMA Physician Profile
- State medical board licensure history
Correct answer: Ongoing Professional Practice Evaluation (OPPE) data
OPPE data is generated internally by the organization and reflects the provider's actual performance within that specific facility.
Question 7: A credentials specialist discovers that a provider failed to disclose a hospital privilege revocation on his reappointment application. This omission is considered:
- A minor administrative error that can be corrected without consequence
- Grounds for denial or rescission of reappointment due to misrepresentation (Correct answer)
- An issue that only the medical staff president can address
- A HIPAA violation requiring immediate reporting
Correct answer: Grounds for denial or rescission of reappointment due to misrepresentation
Failure to disclose a privilege revocation is material misrepresentation and can be grounds for denial or rescission of reappointment.
CPCS Reappointment and Recredentialing 2
A hospital's medical staff bylaws state that reappointment applications must be submitted 120 days before privileges expire.
A physician submits her application 60 days before expiration.
What is the most appropriate action?